1
HESI Exit Exam Neurologic Pharmacology
Bank: NCLEX-Style Questions & Side
Effect Monitoring
Table of Contents
Subtopic 1: Antiepileptic Drugs (AEDs) – Mechanisms, Monitoring, and
Interactions......................................................................................................2
Subtopic 2: Parkinson’s Disease Medications – Dopaminergics,
Anticholinergics & MAO-B Inhibitors...............................................................11
Subtopic 3: Alzheimer’s and Dementia Medications – Cholinesterase
Inhibitors & NMDA Antagonists......................................................................20
Subtopic 4: CNS Stimulants and Cognitive Enhancers – ADHD, Narcolepsy,
and Off-Label Uses.........................................................................................30
Subtopic 5: Antipsychotics in Neurologic Conditions – Extrapyramidal
Symptoms & Monitoring................................................................................39
Subtopic 6: Neurologic Pain Management – Anticonvulsants, Antidepressants
& Monitoring Strategies.................................................................................48
Subtopic 7: Neurologic Emergency Drugs – Status Epilepticus, Stroke, and
Increased ICP Management...........................................................................58
Subtopic 8: Parkinson’s Disease Medications – Dopaminergics, MAO-B
Inhibitors, and COMT Inhibitors......................................................................67
Subtopic 9: Alzheimer’s & Dementia Medications – Cholinesterase Inhibitors
and NMDA Antagonists..................................................................................76
Subtopic 10: Emergency Management of Neurologic Drug Toxicities and
Overdose........................................................................................................86
, 2
Subtopic 1: Antiepileptic Drugs (AEDs) –
Mechanisms, Monitoring, and Interactions
Question 1
A patient prescribed phenytoin (Dilantin) presents with swollen, bleeding
gums. What is the most appropriate nursing action?
A. Discontinue the medication immediately
B. Administer ibuprofen for the discomfort
C. Educate the patient about proper oral hygiene and schedule dental visits
D. Increase the phenytoin dose to reduce seizures
Correct Answer: C
Rationale: Gingival hyperplasia is a known side effect of phenytoin.
Educating the patient on oral care and recommending regular dental check-
ups helps manage this side effect. Discontinuing without a provider’s
guidance is inappropriate.
Question 2
Which lab value should be closely monitored in a patient receiving valproic
acid (Depakote)?
A. Sodium
B. Liver function tests (ALT, AST)
C. Creatinine clearance
D. Potassium
Correct Answer: B
, 3
Rationale: Valproic acid can cause hepatotoxicity, especially in children under
2. Liver function tests are essential to monitor potential damage.
Question 3
A nurse notes a patient on carbamazepine (Tegretol) has developed a fever
and sore throat. What is the most concerning potential side effect?
A. Dehydration
B. Insomnia
C. Agranulocytosis
D. Weight gain
Correct Answer: C
Rationale: Carbamazepine can cause bone marrow suppression leading to
agranulocytosis. The symptoms of fever and sore throat warrant immediate
CBC evaluation.
Question 4
Which is a common side effect of levetiracetam (Keppra)?
A. Visual disturbances
B. Hepatotoxicity
C. Mood changes and irritability
D. Gingival hyperplasia
Correct Answer: C
Rationale: Levetiracetam is known to cause psychiatric symptoms like
aggression, depression, and irritability. Monitoring for mood changes is
important in ongoing assessment.
, 4
Question 5
A patient taking lamotrigine (Lamictal) develops a rash. What is the nurse’s
best response?
A. Apply hydrocortisone cream
B. Notify the provider immediately
C. Tell the patient to stop scratching
D. Reassure that it is a common side effect
Correct Answer: B
Rationale: A rash with lamotrigine can be life-threatening (Stevens-Johnson
Syndrome). Immediate discontinuation and provider notification is necessary.
Question 6
Topiramate (Topamax) is often used for seizure prevention and migraine
control. Which electrolyte imbalance should the nurse monitor?
A. Hypernatremia
B. Hyperkalemia
C. Metabolic acidosis due to bicarbonate loss
D. Hyperchloremia
Correct Answer: C
Rationale: Topiramate can cause metabolic acidosis by promoting renal
bicarbonate loss. Monitor serum bicarbonate and signs of acidosis.
Question 7
HESI Exit Exam Neurologic Pharmacology
Bank: NCLEX-Style Questions & Side
Effect Monitoring
Table of Contents
Subtopic 1: Antiepileptic Drugs (AEDs) – Mechanisms, Monitoring, and
Interactions......................................................................................................2
Subtopic 2: Parkinson’s Disease Medications – Dopaminergics,
Anticholinergics & MAO-B Inhibitors...............................................................11
Subtopic 3: Alzheimer’s and Dementia Medications – Cholinesterase
Inhibitors & NMDA Antagonists......................................................................20
Subtopic 4: CNS Stimulants and Cognitive Enhancers – ADHD, Narcolepsy,
and Off-Label Uses.........................................................................................30
Subtopic 5: Antipsychotics in Neurologic Conditions – Extrapyramidal
Symptoms & Monitoring................................................................................39
Subtopic 6: Neurologic Pain Management – Anticonvulsants, Antidepressants
& Monitoring Strategies.................................................................................48
Subtopic 7: Neurologic Emergency Drugs – Status Epilepticus, Stroke, and
Increased ICP Management...........................................................................58
Subtopic 8: Parkinson’s Disease Medications – Dopaminergics, MAO-B
Inhibitors, and COMT Inhibitors......................................................................67
Subtopic 9: Alzheimer’s & Dementia Medications – Cholinesterase Inhibitors
and NMDA Antagonists..................................................................................76
Subtopic 10: Emergency Management of Neurologic Drug Toxicities and
Overdose........................................................................................................86
, 2
Subtopic 1: Antiepileptic Drugs (AEDs) –
Mechanisms, Monitoring, and Interactions
Question 1
A patient prescribed phenytoin (Dilantin) presents with swollen, bleeding
gums. What is the most appropriate nursing action?
A. Discontinue the medication immediately
B. Administer ibuprofen for the discomfort
C. Educate the patient about proper oral hygiene and schedule dental visits
D. Increase the phenytoin dose to reduce seizures
Correct Answer: C
Rationale: Gingival hyperplasia is a known side effect of phenytoin.
Educating the patient on oral care and recommending regular dental check-
ups helps manage this side effect. Discontinuing without a provider’s
guidance is inappropriate.
Question 2
Which lab value should be closely monitored in a patient receiving valproic
acid (Depakote)?
A. Sodium
B. Liver function tests (ALT, AST)
C. Creatinine clearance
D. Potassium
Correct Answer: B
, 3
Rationale: Valproic acid can cause hepatotoxicity, especially in children under
2. Liver function tests are essential to monitor potential damage.
Question 3
A nurse notes a patient on carbamazepine (Tegretol) has developed a fever
and sore throat. What is the most concerning potential side effect?
A. Dehydration
B. Insomnia
C. Agranulocytosis
D. Weight gain
Correct Answer: C
Rationale: Carbamazepine can cause bone marrow suppression leading to
agranulocytosis. The symptoms of fever and sore throat warrant immediate
CBC evaluation.
Question 4
Which is a common side effect of levetiracetam (Keppra)?
A. Visual disturbances
B. Hepatotoxicity
C. Mood changes and irritability
D. Gingival hyperplasia
Correct Answer: C
Rationale: Levetiracetam is known to cause psychiatric symptoms like
aggression, depression, and irritability. Monitoring for mood changes is
important in ongoing assessment.
, 4
Question 5
A patient taking lamotrigine (Lamictal) develops a rash. What is the nurse’s
best response?
A. Apply hydrocortisone cream
B. Notify the provider immediately
C. Tell the patient to stop scratching
D. Reassure that it is a common side effect
Correct Answer: B
Rationale: A rash with lamotrigine can be life-threatening (Stevens-Johnson
Syndrome). Immediate discontinuation and provider notification is necessary.
Question 6
Topiramate (Topamax) is often used for seizure prevention and migraine
control. Which electrolyte imbalance should the nurse monitor?
A. Hypernatremia
B. Hyperkalemia
C. Metabolic acidosis due to bicarbonate loss
D. Hyperchloremia
Correct Answer: C
Rationale: Topiramate can cause metabolic acidosis by promoting renal
bicarbonate loss. Monitor serum bicarbonate and signs of acidosis.
Question 7
